20875509 tn?1557442796

Help with Armour dosing please

This is my second time trying NDT and I am so confused by my labs and so are my doctors.

I had a TT in 2009 and was on 175-200 mcgs of Synthroid for about 5 years. Always upping my dose to fight fatigue. At this time neither my doctor nor I realized I was a poor converter and he didn’t mind my TSH at .01 (Actually he never tested T3 or T4) At this time I also had terrible anxiety and was taking lexapro

New family doctor came in and surprisingly tested-
My labs on 175/200 mcgs of Synthroid
TSH - .01
T3 - 3.15  (2.5-4.3)
T4 - 1.8  (.8-1.7)

She suggested Nature Throid 97.5 - 1 1/2 grain. I immediately liked it and felt better. My first labs after 8 weeks looked ok but still low T3
TSH .85
T3 2.8
T4 .8

She kept me at the same starting dose and tested 8 weeks later
TSH 4.32
T3 3.47
T4 .8
After seeing my labs she said NDT wasn’t working for me and it was hard to get NT at that time so she put me back on Synthroid. I felt ok at this point but fatigue was returning.
Also, since starting NT I weaned off lexapro effortlessly and anxiety was completely gone.
Started back on much lower dose of Synthroid and after about a month my anxiety also returned!
My last Synthroid labs 100 mcgs
TSH .33
T3 2.79
T4 1.6

Found a new doctor who looked at my last labs and offered up Armour so I’m giving it another go.
113 mgs a little shy of 2 grains (taking a 90 + 1/4 pill)   - 3 weeks
T3 3.4
T4 .9
No TSH lab
His nurse just called and said to stop the 1/4 pill and just take the 90 mgs as he thinks I’m over medicated.  I’m confused as to why he thinks this from my results? It also makes me question his ability to help me find my optimal dose of NDT.
I do see that my labs from both times I’ve been on NDT are similar but I thought maybe I was under dosed.
Any thoughts you have about NDT working out for me? I really want to make it work because I feel so much better on it and my anxiety seems to disappear when I’m off Synthroid.

Thank you for any guidance you can offer,

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Avatar universal
Before further discussion,  do you take your Armour dose all at onece, or split the dose and take 1/2 in the morning and 1/2 in the afternoon?  Also, do you defer your morning dose of Armour until after the blood draw for thyroid tests?   If not, how long after the morning dose was the blood draw for your latest tests?
Helpful - 0
I take my Armour one dose in the morning. I didn’t take my Armour the morning of my blood draw.
Thanks for any info you can share.
Avatar universal
There is much to discuss, but first let's make sure it is clear that your T4 and T3 tests were for Free T4 and Free T3, so that is good.   Always make sure they test for the Frees, not Total T4 and Total T3.  Most of the Totals is bound to protein and thus not active.  The small portions not bound to protein are Free T4 and Free T3.  

Next is to make clear that hypothyroidism is not just "inadequate thyroid hormone".  Instead it is best defined as "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone".   So TISSUE T3 EFFECT determines your thyroid status.  In addition to having adequate Free T4 and Free T3 levels, there are other important variables that affect the response to thyroid hormone.  Two that are very important are cortisol, Vitamin D and ferritin.    D should be at least 50 ng/mL and ferritin should be at least 100.  Cortisol should be tested to assure adequacy.   Also, since you mentioned fatigue, your B12 level should also be tested and supplemented as needed to reach the upper part of its range.  

A good thyroid doctor will do all the needed tests and diagnose and treat clinically (based on symptoms), supported by test results, especially Free T4 and Free T3.    In the untreated state, TSH is useful as a diagnostic only when at extreme levels.   Within their reference ranges TSH has a weak correlation with either of the thyroid hormones.    When a patient is  being medicated with thyroid hormone, TSH is basically irrelevant.   That is because when taking adequate doses of thyroid med in only one or two doses, it causes TSH to become suppressed for most of the day.   That does not mean the patient is hyperthyroid, unless there are hyper symptoms due to excessive Free T4 and Free T3.    Most doctors don't understand this and with a suppressed TSH they think there is a need to reduce the dose.  Since you had no test result for TSH even, I have no idea why the doctor decided to reduce your dosage.   As long as you continue to have hypothyroid symptoms, the dosage should be gradually increased until there is symptom relief.   Every person is different in their thyroid heed, but typically this seems to take Free T4 approaching the middle of its range, and Free T3 in the upper part of its range.  In addition you need to get tested and then supplement as needed for Vitamin D, B12 and ferritin.  

So you are going to need to discuss this with your doctor and see if you can give him enough info to persuade him to increase your dosage not decrease.   Toward that goal, you might make good use of this link.


In this study the authors quantified for the first time the effect of Free T3 on the incidence of hypothyroid symptoms.  They concluded,  'Hypothyroid symptom relief was associated with both a T4 dose giving TSH-suppression below the lower reference limit and FT3 elevated further into the upper half of its reference range. '   Of course to achieve these levels usually requires the addition of T3, or a switch to a desiccated type like Armour.  

Also you can click on my name and then scroll down to my Journal and read at least the one page overview of a paper on Diagnosis and Treatment of Hypothyrodisim: A Patient's Perspective.  There is also a link to the full paper.   Everything I have stated here is supported with extensive scientific evidence.   You can also use the Overview with your doctor.  
Helpful - 0
Thank you so much for the information and your time.  I’m off to read your recommendations.
Also to address a few other things you mentioned, my vitamin D was low (22) in March. My doctor at that time gave me D2 50,000 units to take once a week and even I knew that wasn’t the best form of D to take . I’ve been trying to supplement with D3 but I don’t think my body likes vitamin D supplements so I’ve been trying to get some sun when possible.  In March my B12 was 222 but my doc at that time thought it was fine (within range) My new doctor tested my B12 again this week and it was 325 which he was happy with.  I did use some B12 sublinguals in April but I didn’t know how much to take and I didn’t want to create a bigger problem. I had read that I needed to take a B complex while taking extra B12 and most B complex stirs up my anxiety. I’ve never successfully  taken supplements of any kind so it’s uncharted territory for me and like I said they usually make me more anxious.
My cortisol and ferritin haven’t been tested.
Since being switched to Armour my symptoms are improving.  I have some occasional anxiety and body aches but nothing like I had a month ago. I sleep pretty good and seem to have a little more energy than before. I was feeling quite hopeful with the changes in only 3 weeks of taking Armour but worrying now because my doctor is already trying to stop increases.

Again thank you for your time.
Avatar universal
You need Vitamin D at least 50 ng/mL.  I doubt that you will get sufficient D from the sun.  I suggest that you supplement with about 2000 IU of D3 daily, or if that does not work for you then ask the doctor to give you injections to optimize your level.  Vitamin D is very important for you.    Also, B12 should be in the upper end of its range, so you can supplement with about 500  mcg of B12 daily.  It is also important to know your cortisol and ferritin levels since they affect thyroid metabolism.  

Of course the most important thing is to understand why your doctor is reducing your dose, when it is likely that you need a slightly higher dose.   Everyone is different regarding what thyroid levels work best for them, so med dosages should not be based solely on FT4 and FT3 test results, and never based on TSH levels.  So, you should try to get agreement with the doctor that the objective is to get your meed dosage to a level that relieves your hypothyroid symptoms.
Helpful - 0
Thank you for the info.  Do you think I need to take a B complex if I am supplementing B12?  Also, have you heard of others that can’t take D3 supplements?  They make me feel worse.
Avatar universal
If you think the B complex stirs up your anxiety, why take it, just take B12.  I have only heard from one other member who felt they had problems with D3 supplements.  We recommended taking D3 injections and then when it was optimal try D3 supplements daily.  I don't recall ever hearing anything further from the member.   I mention cortisol because it is an antagonist of thyroid.  Ferritin is very important for its effect on conversion of T4 to T3.  A ferritin deficiency can also cause symptoms.  Ferritin needs to be at least 100.   It would be good to get a full iron test panel, including ferritin.  
Helpful - 0
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